Why Seniors Oppose Government-Run Health Care (Except for Their Own)

"We need to protect Medicare," Republican National Committee Chairman Michael Steele exhorted last week, "and not cut it in the name of 'health-insurance reform.' " It was a rousing defense of government-run health care from the . . . conservative chairman of the GOP. But incoherence doesn't necessarily make for bad politics. In this case, Steele was aiming his message directly at America's seniors. Lucky for him, they share his incoherence in full.

In late July, President Obama recounted a letter from a woman who told him, "I don't want government-run health care, I don't want socialized medicine, and don't touch my Medicare." The president chuckled. "That's what Medicare is," he protested at an AARP town hall. "A government-run health-care plan that people are very happy with."

Jokes aside, the White House is struggling to attract seniors to health-care reform. No age group is as solidly opposed to the project as the over-65 set. But that's the same set that relies on government-run health care and loves it.

That's not how it's supposed to work; successful government programs are supposed to create constituencies for their expansion. But the happy experience of Medicare has made seniors less, not more, open to a generous welfare state. It hasn't created advocates for more single-payer health care; it has created advocates just for Medicare. And they fear that health-care reform will endanger Medicare.

Resolving this tension could decide the future of Obama's make-or-break domestic policy push. The opposition of seniors matters. Older people vote in bigger numbers than younger people do; they're more likely to call their representatives or attend a town hall meeting. Most important, says Robert Blendon, a Harvard scholar who studies public opinion on health care, "they make off-year elections. The secret about Congress and health policy is that in 2010, there will be a lot more seniors at the polls than there were in 2008."

Just ask Bill Clinton. In September 1993, the strongest supporters of his plan to reform the health-care system were seniors. A solid 62 percent approved of his efforts. By April 1994, the president had lost 25 points among seniors, and they were his weakest backers. "In the Clinton plan, it didn't come out till later that the financing came substantially from Medicare," Blendon says. But once it did, seniors revolted. In that fall's midterm elections, Democrats lost more than 50 seats in the House. Seniors were a big part of the reason -- giving Republicans 51 percent of their votes.

Seniors are moving in a similar direction this year. A Washington Post-ABC News poll this month found that only 35 percent of people 65 and older approved of Obama's handling of health care. Compare that with 44 percent of respondents between the ages of 30 and 64, and 57 percent of 18- to 29-year-olds. More telling, only 8 percent of seniors thought reform would improve their health care, while 42 percent thought their care would get worse. All this despite the fact that a staggering 94 percent of seniors are satisfied with the quality of care they receive, and Medicare polls much better than the private health insurance market.

What are seniors so afraid of?

From the beginning, Medicare has been named as one of the potential sources of savings that would fund subsidies for the uninsured. That sounds like service cuts, even if the specific changes don't involve anything of the kind (most of the savings would come from reducing overpayments to the private insurers that participate in the Medicare Advantage program).

So the fear is not of a welfare state but of changes in their welfare state. The result is that the coalition against reform is an odd union between people opposing government-run health care and people defending government-run health care. It's a potent combination.

Seniors are also the most conservative segment of the population and are getting more so. They constitute not only the sole age group that Obama lost in last year's election, but also the sole age group in which his results were worse than those of John Kerry in 2004. And both Obama and Kerry underperformed Al Gore's 2000 results.

"The Roosevelt seniors are being replaced by the Reagan seniors," says Paul Begala, who helped run Clinton's 1992 campaign. A May poll by the Pew Research Center found that for the first time in 20 years, the GOP is now an older party than the Democrats.

The June Post-ABC poll asked whether respondents would prefer a smaller government with fewer services or a larger government with more services. Seventy percent of seniors -- the segment of the population with government-run health care and a government pension, also known as Social Security -- preferred a smaller government, compared with 37 percent of people 18 to 29. Seniors are the age group most solidly opposed to the public option. In fact, in the August Post-ABC poll, they were the only age group in which a majority opposed it. "Seniors are like the American West," says Julian Zelizer, a Princeton historian. "They depend on government and then say they hate it."

But taken as a whole, the attitudes seniors express on health care are arguably the greatest vote of confidence anyone has offered reform. Seniors live in America's version of Canada. They have single-payer health care. And they love it. They love it so much that they've got the chairman of the RNC swearing to protect it.

I'm wondering if the reason for this high voter turnout is the fact that a greater majority of the over 65s are retired and don't have to manipulate around work to go vote. Any studies been done on this problem? Would a change in how and when we vote narrow that gap?

the" don't trust anybody under 70 generation!" i think there is a psychological component in dealing with older folks, as well, that shows up in this debate, which makes it even more irrational and difficult to deal with.
anger about growing old and feeling marginalized and unappreciated, manifests itself as a jealousy, selfishness and anger toward "the younger generation."
unfortunately, instead of older folks often wanting to be charitable and kinder to young folks, i think some feel robbed of their youth, health and autonomy, and "take it out" on younger folks.
if they have to suffer growing old, sick and having their dreams taken away from them, some want to take the whole ship down with them.
ironically, seniors, especially the post-babyboomers, who have seen their world change so dramatically over their lifetimes, seem to have become the narcissistic, "me-first" generation....and not the young folks.

The GOP has already peed in the pool with their lies. If the game is to unconvince everybody who ever heard misinformation you may as well get another job because as you've published on your blog people tend to remember the lies at a much greater rate than the truth sets them free.

Obama won the election. He needs 50 Senate Democrats to remember that who also understand that the only poll conditions that matter are AFTER the system is in place and voters can experience first hand the new system.

were you able to track down anything about that comment Karen Ignani made about the 14% different in per person reimbursement between Medicare Advantage and Medicare being the result of some aggregate numbers?

Are seniors ignorant of the facts surrounding their medical care program (socialist!) and supplemental security income (socialist!)? Or are they deliberately ignoring the facts about these programs and content to say "screw the rest of you, but don't you dare touch my government-funded, government-run program!"?

Elsewhere in the liberal blogosphere I've read it claimed that the '94 election happened because health care reform didn't pass. Now it's supposedly because seniors were afraid health care reform would have cut Medicare. We need a blogger ethics panel to get our stories straight on what the real reason for the 1994 election defeat by Democrats was. Or maybe we can just get over a 15 year old election already and pass a good bill then go out and defend it to voters.

Ezra - You make some compelling points about the paradox of Medicare beneficiaries adamantly opposing reform, but are their fears completely irrational? Nearly half of the House bill (over $500 billion) is paid for through eliminating "waste, fraud, and abuse" and promoting "efficiency". The nebulous phrasing doesn't exactly inspire confidence that benefits will be kept in tact. Most seniors aren't policy wonks, so how do you give seniors peace of mind when you're reallocating such a large portion of the existing system?

Thank goodness there are so many seniors in the Senate who can talk to their elderly constituents and calm their fears! August Senators like Grassley (R-IA age 76), and Enzi (R-WY age 65), and Baucus (D-MT age 68); all of them in the thick of negotiations on this very topic.

Come to think of it, this is the very purpose of the Senate, isn't it? To use their wisdom and experience to prevail over fear and craziness?

Sorry to bring this up, but many of the seniors I know personally do not like Obama because he is not white. Even the Democrats primaried for Hillary. When these people were in their 30's, they barely had to ever look at or think about minorities and they liked it that way. I do live in The South and all that but it would not suprise me to know that this attitude is all over the country.

As an earlier commenter said, this is the "I've got mine" coalition. And my age cohort (30-to-39) is the "I'm getting screwed" coalition - we're the ones who have to pay into Social Security, and whose taxes fund Medicare, but these benefit programs will be long gone by the time we need them. And, courtesy another bunch of liars who got theirs, my 401(k) got vaporized last year; the idea of a comfortable retirement is a sick joke.

Can someone please remind me why I'm not supposed to be bitter about politics, and also respect my elders, because I've forgotten.

"But taken as a whole, the attitudes seniors express on health care are arguably the greatest vote of confidence anyone has offered reform. Seniors live in America's version of Canada. They have single-payer health care. And they love it."

Cute, but dumb. Medicare is subsidized. On average, participants get far more than they pay. If you can figure out a way to provide subsidized health care to the entire country, so that, on average, participants get far more than they pay, I will agree with you that the popularity of Medicare with seniors means anything. Otherwise, give me a break.

Seniors oppose it because the unsustainable reality of Medicare has (thankfully) not yet begun to sink in, and because the goal of the plan is to redistribute care to people who, seniors would argue, have not earned it.

Yes, you made Medicare too good. Now the seniors are a major factor in resistance to the new rationing model.

Medicare is TOO GOOD in many respects. Not as good in others. The deals they have are unsustainable as we are all figuring out. With the greed in every sector everyone will keep pulling from the system until it implodes within itself.

Ezra wrote: "From the beginning, Medicare has been named as one of the potential sources of savings that would fund subsidies for the uninsured. That sounds like service cuts, even if the specific changes don't involve anything of the kind (most of the savings would come from reducing overpayments to the private insurers that participate in the Medicare Advantage program)."

With due respect, Ezra, this is simply hogwash. There is no possible way to cut $500 billion+ over 10 years from Medicare WITHOUT reductions in services and reimbursements. Simply no way.

Do you read your own newspaper? A recent article outlined the Senate Finance Committee's plans--a means test for prescription drug coverage, and at least $125 billion in payment reductions to hospitals. Medicare Advantage cuts make up about one third of the savings.

So either you're unfamiliar with what's going on, or you're being disingenuous. Which is it?

I am 62 and don't receive either Medicare or SS, but I do a lot of volunteer work with seniors who do receive both. The overwhelming number of them are people who have paid into SS and Medicare most if not all of their working lives. In fact seniors who made a modest amount of income when they worked paid a higher percent of their income in FICA taxes than a lot of the better-off in our society. There is nothing disturbing about their wanting to receive what they have paid for for years.

Nor is there anything disturbing about their questioning how a public option, etc will be financed. They would be stupid not to do so.

FWIW I don't believe that we are about to start euthanizing Granny, I support a public option, and I even spoke in favor of health care reform in Bristol, VA at a rally when BHO was in town; but this I will say: Obama stood in front of us and stated that health care will not go to illegal aliens, all the while knowing that there was absolutely zero enforcement attached to this provision. In fact, the house had removed a provision requiring enforcement and replaced it with the current one by Rep Space that deliberately left enforcement out so it was no accidental oversight. BHO has to know this.

IMO, Obama lied to us because he knows that illegal aliens will get health care under this bill, regardless of what it says AND he knows that a poll showed that 80% opposed this. Furthermore he has to know that because most illegal aliens are unskilled and poorly educated, they will have to have heavy subsidies in any health care plan.

We have seen what passing laws that prohibit hiring illegal aliens and then not providing for strict enforcement can accomplish: massive hiring of illegal aliens with massive unemployment of US citizens along with depressed wages for those still employed.

So, if he's willing to lie straight-faced to us about that to our faces, why should anybody believe him on any other provision of the bill, including not euthanizing Granny or at least not rationing her care? It's kind of difficult to believe and/or trust somebody who will go on nationwide TV and lie as brazenly as BHO and various members of Congress did on this issue.

He is really screwing himself on this issue. Old folks vote and there are are lot of them out there.

Ezra,
You are assuming that Obama has come out with a full-throated endorsement of government run health finance. He hasn't.

He has appeared to be anxious and tentative in his endorsement of the public option.

You are writing as if Obama has campaigned on and praised the efficiencies of Medicare when in fact he treats it as an embarrassment or worse. Therefore, I think that seniors are hearing the need to cut costs, which Obama thinks makes him more politically attractive than the part that is about ensuring all have access to health care.

I would find the seniors responses more puzzling if Obama had been advocating a "Medicare for all" single payer system...you are writing as if he has when he hasn't.

"Seniors live in America's version of Canada. They have single-payer health care. And they love it. They love it so much that they've got the chairman of the RNC swearing to protect it."

Wrong, Ezra.

Medicare as it exists now is not single-payer unless you consider single payer to be a plan that a client of necessity (so as not to end up bankrupt if he comes down with a serious illness or has a bad accident) needs to buy 2 PRIVATE insurance plans as supplements. If you have Medicare and are not poor enough to get further governmental assistance, you need a MediGap policy to cover the 20% of your costs that Medicare doesn't pay and a Part D plan for your drugs. Both of these are private insurance and if you want dental and vision coverage, you need insurance for that as well. Or you can pay for all of these services yourself and good luck with that plan.

Most people, even most people living on Social Security alone, are not poor enough to have total coverage. Right now it takes about 3 payers for the average Medicare client to get health care without facing bankruptcy if he really needs serious health care: Medicare, PRIVATE Med-Gap or Medicare supplement and a PRIVATE drug plan.

Even then, if a senior falls into the doughnut hole, he - or more likely she - will pay the total cost of drugs for several months PLUS all of the premiums. I've had folks whom I help with their Part D plans have to pay over $800 a month for several months in the doughnut hole. Most can't afford it and so stop taking at least part of their drugs.

Reagan Seniors, what a perfect group to kill healthcare reform. One of the underlying themes of the Reagan revolution was to hate government while taking as much government aid as possible. That the birth place of Reaganism was southern California; fed by government subsidized water, built with government money for defense industries, and nurtured by government farm supports was always the ultimate irony. Reagan was smart enough to keep doling out the goodies to his people, while burying the country in debt with tax cuts for the rich.

Now, 30 years later, these Reagan folks are screaming about hating government, while demanding bigger medicare for themselves and yelling that Obamacare will give their tax dollars to cover illegal immigrants, an extension of Reagan's "Cadillac driving welfare queens". A bigger group of hypocrites would be hard to find.

Dflinchum - you're absolutely right, illegal aliens will get healthcare under the new proposal, exactly like they do now: they'll show up at the emergency room, where by law they have to be treated (as does everyone else who shows up), and then the costs of their care will be borne by me and everyone else who pays health insurance premiums, as we pay $25 for an aspirin so that hospitals can offset the costs of treating the uninsured. But if it makes you feel better to call the President a liar, go right ahead. That's the kind of helpful argument that got us to this juncture in the first place, and will keep us here until the costs of paying for healthcare ultimately bankrupt us.

Tom Servo, illegal aliens will be covered under the house bill. A member of the Congressional Hispanic Caucus told Roll Call's Jennifer Bendery that the health bill (H.R. 3200), as drafted, would allow illegal aliens access to federal health benefits. I am well aware that illegal aliens use the ER as a clinic. My solution for that is to institute E-Verify everywhere, send out no-match letters, and shut down the jobs magnet. Attrition through enforcement. It works.

The drift of EK's story is that seniors are the least supportive of health care reform. When the President goes on nationwide television and deliberately lies to people about one controversial aspect of a bill (coverage for illegal aliens), we should not be too surprised that people don't believe him and his supporters regarding other controversial aspects of a bill (rationing health care for seniors).

He would have been better off telling the truth. Granted there would have been an uproar that likely would have restored the enforcement provision, which BHO and most of the Dems do not want to happen. So he simply lied.

dflinchum
Which member of the Congressional Hispanic Caucus? Got a link to a video? A letter? Some way for us to verify that this congressperson is not making stuff up? Because you're accusing the President of lying in public on the basis of whatever this Congressperson said, it would be helpful to have some more details, so we can assess the veracity of that person's claims for ourselves.

If Medicare and Medicaid are going broke how will expanding them save us money or even be affordible? I'm curious why you keep pretending a single payer is even possible?

Some might argue the one hope that Medicare has is in first getting a comprehensive supply and demand solution (Wyden/Bennett) for the working ages done that controls medical inflation and does not bleed us dry. Then you go in and require the wealthy seniors to cost share switch over to pay for performance etc. Private insurers will not sell to the over 65 as a group the government plan is literally all they have. Were the president to back up with CBO numbers that premiums were going down and Medicare benefits being maintained reform would happen. But the curse of Jacob (Hacker) with a little help from labor is killing all first born bipartisan compromise.

What Medicare for all really is is Medicaid for all in a system no one can get out of. Which is why seniors are against it.

I'm one of those your article is about. I'm not over 65 but I am on Medicare as the result of a disability.

I'm in favor of health care reform, but I understand a little bit about why others on Medicare oppose it.

Every Republican president since Medicare became law has tried to gut it and end it. Republican lawmakers have made it more difficult for doctors to accept Medicare, by changing (and reducing) reimbursement rates and by providing subsidies to private insurance for MA plans, among other arcane changes.

Mismanagement and under-funding and excessive paperwork for health care providers has taken its toll over the years, too, and has turned a lot of people against it, even if they have no other form of health care.

Medicare isn't perfect and doesn't provide a lot of services and benefits that private health care does and there is a sense among those with Medicare that they are helpless to change it or improve it because it is a big bureaucratic government program, but it is all they know and have and don't want it changed.

What would you do, if this was your only health care option?

Finally, I am one of those who turned to a MA plan because traditional Medicare doesn't provide essential services and benefits (like vision care coverage, like dental care) that I need. Additionally, for those on Medicare to participate in the prescription drug plan they must purchase a plan, which means they pay two monthly premiums each month: one to cover Medicare Part B and another to cover Medicare Part D. MA plans offer something that traditional Medicare doesn't - reduced or combined premiums for both health and prescription drug coverage, which makes MA more attractive to a lot of seniors.

There is real fear among those of us on Medicare that our costs will go up and our benefits will change or be reduced as a result of some of the reform proposals (and if you and President Obama and others are honest, you know this will happen because of reduced subsidies to MA plans, especially).

I don't understand why progressives can't admit this and address these fears honestly, instead of pooh-poohing the concerns and fears and/or placing the blame on seniors for not supporting health care reform, because putting on blinders and pretending, or acting as if they really don't matter, or treating our concerns and fears lightly will make it more difficult to get real health care reform!

As you must have noted, Tom Servo, I did not accuse BHO of lying based upon the statement of a member of the CHC. I merely mentioned that in later email. I accuse him of lying because he had to know that Deal's provision requiring enforcement of the "No Health Care For Illegal Aliens" Section was removed and replaced by Spaces's provision with no enforcement attached largely along party lines. FWIW the Roll Call article is here and as might be expected the CHC member "requested not to be identified". http://www.rollcall.com/news/37180-1.html

For a good run-down on this issue, try
http://cis.org/IllegalHealthcareReform

"Someone's got to wipe your grandma's rear at the care home, dflinchum. You're not volunteering for the job."

My grandparents and parents have been dead for decades, pseudonymousinnc. So you're right, I don't have to "volunteer for the job." However, I find it a bit odd that you seem to think only illegal aliens work in "care homes". As it happens many US citizens, primarily uneducated and unskilled and quite often minorities work there. By not enforcing our immigration laws, we are allowing the biz interests to use illegal aliens through the simple law of supply and demand to drive down wages in these types of jobs - jobs that I believe should be decently paid because "wiping anybody's grandma's rear end" is an unpleasant task and should be rewarded in part as a result of that unpleasantness.

We are also allowing them to pass a great deal of the true costs of that "cheap" labor to the community at large. By paying lower wages, the biz interests can move the profits up the ladder and to costs out into the public sector. Meatpacking, a job that used to pay the best wages/benefits in the industrial sector of the US has seen wages decline by 45% since the 80's. During the housing boom, construction wages fell. Both of these came about largely because illegal aliens flooded the market with lots of cheap (to the biz interests, that is) pliant labor.

What I can do is help a lot of people's grandparents or parents figure out the Medicare system, especially Part D, and help people like ljwalker figure out MA plans. I do this as a volunteer.

What else I can do is alert people who actually understand the law of supply and demand that a steady supply of cheap (to the biz interests, that is) compliant labor doesn't help our own unskilled and poorly educated citizens.

See
http://cis.org/WorseThanItSeems
and
http://cis.org/illegalImmigration-employment

for more information on THIS particular issue. Thanks for bringing it up. I hadn't planned to.

Considering all the folks who want the government off of their medicare, I think Obama's number 1 problems isn't just an unclear message, but ignorance.

With the campaign he made a full length film to elaborate on his message. I think something like that for his health care plan could go a long way (even a Powerpoint presentation would help at this point!)

How dumb and unfair does reform need to be? That is the question. Too much of a good thing running it into the ground? That reminds me lets try capping the employer provided health insurance tax exclusion. It's wrong for someone with no insurance to subsidize someone with a gold plated plan. But that would make sense wouldn't it?

" .. Oregon's health care efficiencies work against Oregonians when it comes to the complex and politically-charged Medicare system. "

" "The simple truth is, if the practice patterns in metropolitan Portland were applied nationwide, Americans would get better health care and we wouldn't have a Medicare funding crisis," he said.

But he's also pragmatic and understands history.

"One person's subsidy is another person's constituent, Blumenauer said. "When you have somebody who is making huge sums of money on something, they have quite an incentive to keep it the way it is or to spoil it." "

If Obama had said that Veteran Health Benefits would be a potential source of savings that would fund subsidies for the uninsured and polls showed that Vets were against using VA Benefits to fund reform
would you have written this headline on your blog?

Poor Ezra seems stumped by the concept of balance and moderation. The left simply can't process the idea that just b/c gov't can and should do some things (e.g. medicare), it doesn't automatically follow that it should expand itself into everything else. (e.g. stretching medicare across the entire market).